Mortgage_Ziliak^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 7ownship vear
Fr .
FOR DEDUCTION FROM ASSESSED VALUATI� ��
' Sfate Fortn 43709 (R11 / 6-09)
�' ,w l presrn3ed Gy �epartrtrent af Lowl Govemrtrent Firwice
File Mark
INSTRUCTIONS: nC(� g n ��%
To be filed in person or by mad with the CountyAuditor or Counry Recorder o/ fhe cnunty whA�tAe Qlo�e�`is Tocafed. F� �� ��
Ffig Dates: 1J Real Properfy. Must file during the year Por which the deduclion is soughL � Counry Auditor
2) Mo6de / Manufactuled Homes rrot assessed as Real Property: Must file d�rntg fR,¢ ths
be(ae March 31 of each year Me deduclion is sought - ❑ Counry Recorder
See reverse side loraddi6onal instructiwis end qualifications. __„ ,,,�� �uTY AUDITOR
AsesseE vahe d real pmperty es W Mw�qage / Contrart'ude6tr�ness unpaH as of Mwigaga I ConvacY cdebtetlness �mpaid as d Is Ihe ePP�t the sde
MaN� 1. qmnt year Ma`ch t curtepnt y^esr date of aDP�� legal or equitahle arrtreY7
p � ❑ Yes ❑ No
tt ro. wtat k his ! her euct share of interest? tt owneO wi� someofre atl�u Ihan spouse, mdicate with wham
If name an 2mN is ddterent ihan fhat o/ appGrant trMinte bebw. jI5�y5�e Property in QuesOOn: Mnua%AtiscsM
IL7 Real RoPeKY ❑ Arm�aly Ass�sed
Alabde Fiome C 61.1-i
r�m ce raa�y�ier
mn��1J-CQi1
Address of mortga9ce a tract seAer (numbe� end sfreet �'+ry, sta�. end LP codej
Nama ot assi9nea or other owner w hdder of mortgage
Atldress of assignea (number ard SheeL a1y, sta2e, aM LP oode)
� w�vem
Yes
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